Healthcare Provider Details

I. General information

NPI: 1073047825
Provider Name (Legal Business Name): NEW MEXICO SPECIALTY MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 LA ORILLA RD NW STE D3
ALBUQUERQUE NM
87120-2742
US

IV. Provider business mailing address

8613 SNOWY OWL WAY
TAMPA FL
33647-3416
US

V. Phone/Fax

Practice location:
  • Phone: 505-873-2064
  • Fax: 877-335-6410
Mailing address:
  • Phone: 772-708-6776
  • Fax: 888-731-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DEBRA MICHELLE SHELBY
Title or Position: OWNER
Credential: ARNP
Phone: 772-708-6776